Biliodigestive Anastomosis in Liver Transplantation: Review of 13 Years

Abstract

Hepaticojejunostomy is a good alternative technique for biliary reconstruction in liver transplantation. Among 517 liver transplants performed between March 1992 and July 2005, 33 involved hepaticojejunostomy, namely, 18 men and 12 women of average age: 44.8 years. The main cause for this technique was retransplant ( n = 10), secondary biliary cirrhosis ( n = 5), alcoholic cirrhosis ( n = 5), HCV cirrhosis ( n = 2), primary biliary cirrhosis ( n = 1), cryptogenic cirrhosis ( n = 1), sclerosing cholangitis ( n = 3), fulminant liver failure ( n = 1), autoimmune cirrhosis ( n = 1), and insulinoma metastasis ( n = 1). Choledochojejunostomy was performed for all Roux-en-Y loops, with an average cold ischemia time of 361.16 minutes (180–780). The biliary complications were biliary fistula in four cases (13.3%), including two who required surgery; stenosis of the anastomosis in two cases (6.6%) including one diagnosed by HIDA that resolved with medical treatment and the other, diagnosed by cholangio-MRI, requiring a new hepaticojejunostomy; and biliary peritonitis in three cases (10%), all of whom required surgery. The vascular complications were thrombosis of the hepatic artery ( n = 1), which required retransplantation, and pseudoaneurysm of hepatic artery ( n = 1). No biliary complications occurred. The 6-month patient survival was 80% and the 6-month graft survival was 77%; no patient died due to biliary complications. Hepaticojejunostomy is a technique with higher morbidity than choledocho-choledochostomy, but it is the best alternative when the latter is not possible.